Papillary Thyroid Cancer
Thyroid gland: Located at the bas e of the throat, an organ that makes hormones affecting heart rate, blood pressure,
body temperature, and weight.
Papillary: Refers to an architectural pattern of growt h similar to an arborizing pattern of a tree.
Goiter: Non-cancerous enlargement of the thyroid gland.
Nodules: Cellular growths in the thyroid gland. These growths are usually benign but may be cancerous.
Pathologi st: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment
What is papillary thyroid cancer?
About 44, 670 Americans are diagnosed with thyroid cancer each year, according to the National Cancer Institute. Thyroid
cancer incidence is increasing at a faster rate among American men and women than any other type of cancer.
Papillary thyroid cancer, which accounts for about 80 percent of thes e cases, is a cancer of thyroid follicular cells. Most
people diagnosed with papillary thyroid cancer at an early stage can be cured. About 1,500 Americans die from all types
of thyroid cancer each year. This relatively low death rate is due to successful early detection and treatment in most
Who is likely to have papillary thyroid cancer?
Women are three times more likely than men to have papillary thyroid cancer. Most cases afflict individuals between the
ages of 30 and 50. Associated risk factors include radiation exposure, a family history of thyroid cancer, and too much
iodine in the diet. Less often, papillary thyroid cancer is associated with having a goiter, benign thyroid nodule, or multiple
colon growths (familial polyposis). Also, papillary thyroid cancer has been linked to nuclear weapons testing in the western
United States and to accidents in nuclear power plants and atomic weapons production facilities (for example, the
Chernobyl nuclear facility accident).
What characterizes papillary thyroid cancer?
Papillary thyroid cancer is characterized by its papillary architectural growth patt ern but more importantly by the changes
in the appearance of the nuclei of the tumor. Any cancerous nodule can become life-threatening by spreading via
lymphatic spaces or blood vessels to lymph nodes or nearby bones and other organs. However, among all ma lignant
neoplasms, there is a low deat h rate for papillary thyroid cancer.
Nodules can be detected when your primary care physician checks your neck and throat and feels the thyroid for
lumps. Otherwise, early thyroid cancer does not have symptoms. If the cancer grows, symptoms may include a lump in
the front of the neck, hoarseness or voice changes, swollen lymph nodes in the neck, trouble swallowing or breathing, or
throat or neck pain.
How does the pathologi st make the diagnosi s?
If your symptoms suggest the possibility of thyroid cancer, your physician will order a blood test that the pathologist will
check for abnormal levels of thyroid-stimulating hormone (TSH). Too much or too little TS H shows that the thyroid is
not working well. Blood test results also can show a changed RET (Rearranged during Transfection) gene passed from
parent to child.
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What else does the pathologi st look for?
Your primary care physician may order an ultrasound and thyroid scan for review by radiologists. Cells removed by
fine-needle aspiration (FNA) or tissue removed by a biopsy are sent to the pathologist to examine. An ultrasound or
thyroid scan creates images of thyroid nodules that the radiologist can view for signs of cancer. An FNA or a biopsy,
however, are the only potential sure ways to diagnose cancer.
What is meant by the stage of the cancer?
Your pathologist and primary care doctor determine the canc er’s stage to plan the best treatment. This process involves
determining the size of the cancerous nodule, whether or not the cancer has spread and, if so, to what parts of the body.
Thyroid cancer spreads most often to the lymph nodes, and much less often to the lungs and to bones. Stage 1 cancers
are small and confined to the thyroid, and stage 4 tumors have spread well beyond the thyroid. Stages 2 and 3 describe
conditions in between these two extremes.
Staging may involve tests such as ultrasound, CT or MRI scans, chest x-rays, or whol e body scans. These tests
enable the pathologist to determine where the cancer has spread and its stage.
How do doctors determine what treatment will be necessary?
Your treatment will depend on the size of the nodule, your age, and whether or not the cancer has spread. The pat hologi st
consults with your primary care physician or specialist. Together, using their combined experienc e and knowledge, they
determine treatment options most appropriate for your condition. It’s import ant to learn as much as you can about your
treatment options and make the decision that’s right for you.
What kinds of treatments are available for papillary thyroid cancer?
Papillary thyroid cancer may be treated with surgery, external radi ation therapy, thyroid hormone treatment,
radioactive iodine therapy, or chemotherapy. Many patients receive a combination of thes e treatments.
Surgery and external radiation therapy are local therapi es that remove or destroy cancer in the thyroid. When the
cancer has spread beyond the thyroid, these two therapies can control the disease in the thyroid. Common surgic al
procedures are the total thyroidectomy (removal of the entire thyroid gland), the lobectomy (removal of part of the
thyroid), and lymphectomy, which removes lymph nodes where the cancer has spread. External radiation therapy is
generally used after surgery; this therapy uses high-energy beams projected from outside the body to destroy any
Thyroid hormone treatment, radioactive iodine therapy, and chemotherapy are systemic therapies delivered through
the bloodstream to destroy or stop the progression of cancer cells present throughout the body. These therapies also can
Any of these treatments may cause side effects and alter your normal activities. Ask your primary care physician or
specialist to explain possible side effects thoroughly. If your treatment removes or destroys your entire thyroid, or a large
portion of your thyroid, you will be required to take thyroid hormone pills for the rest of your life to replace the natural
thyroid hormone. If the surgeon removes the parathyroid glands, located behind the thyroid, you will need to take calcium
and vitamin D supplements for the rest of your life.
Follow-up care is very important because thyroid cancer comes back in up to 30 percent o f all cases. Also, if you
receive radioactive iodine therapy or external radiation therapy, you have an increased chance of developing other
cancers later in your life. You should receive regular blood tests to check your levels of TSH and thyroglobulin (thyroid
hormone stored in the thyroid). Your physicians also may recommend repeating some of the diagnostic and staging tests
to see if the cancer has ret urned.
Clinical trial s of new treatments for thyroid cancer may be found at www.cancer.gov/clinicaltrials. These treatment s
are highly experimental in nature but may be a potential option for advanced cancers. Some trials may involve biologic
therapy, which uses the natural defenses of the immune system to fight cancer.
For more information, go to www.cancer.gov (National Cancer Institute), www.medicinenet.com (owned and operated
by Web MD), or www.thyca.org (Thyroid Cancer Survivors’ Association). Type the keywords thyroid cancer into the
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What kinds of que stions should I ask my doctors?
Ask any question you want. There are no questions you should be reluc tant to ask. Here are a few to consider:
• Please describe the type of cancer I have and what treatment options are available.
• What is the stage of my cancer?
• What are the chances for full remission?
• What treatment options do you recommend? Why do you believe these are the best treatments?
• What are the pros and cons of these treatment options?
• What are the side effects?
• Is your medical team experienced in treating the type of cancer I have?
• Can you provide me with information about the physicians and others on the medical team?
• If I want a second opinion, could you provide me with the names of physicians and/or institutions that you would